Globalizing Leprosy
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Globalizing Leprosy A Transnational History of Production and Circulation of Medical Knowledge, 1850s-1930s Magnus Vollset Dissertation for the degree philosophiae doctor (PhD) at the University of Bergen 2013 Dissertation date: December 13, 2013 2 © Copyright Magnus Vollset. The material in this publication is protected by copyright law. Year: 2013 Title: Globalizing Leprosy A Transnational History of Production and Circulation of Medical Knowledge, 1850s-1930s Author: Magnus Vollset Print: AIT OSLO AS / University of Bergen 3 Acknowledgements This thesis is part of Project History of Science (‘Prosjekt vitenskapshistorie’) and the research group Health-, welfare and history of science at the Department of Archeology, History, Cultural Studies and Religion (‘AHKR’) at the University of Bergen. I would like to thank the University Board and the Faculty of Humanities for funding this four-year project. I am also grateful for the scholarship from the Meltzer Foundation, which allowed me research stays at the League of Nations Archives in Geneva and at the Wellcome Trust Center for the History of Medicine at UCL, London. Many people have aided me in this research project, most importantly my supervisor Astri Andresen. Already when I was a master-student she began to introduce me to the vibrant scientific community investigating the history of health and medicine, both locally and internationally. I am grateful for your patience and guidance, for the many discussions, for allowing me freedom to experiment and sidetrack, for motivation when I have been overwhelmed and for constructive advice when I have felt stuck. I might have protested loudly along the way, but in the end you were usually right. I would like to offer my gratitude to the members of the project and the research group, the fierce discussants at the Bjørnson manuscript seminar and the Nordic Network of Medical History’s PhD-courses. Svein Atle Skålevåg, Morten Hammerborg, Teemu Ryymin, Tore Grønlie, Sissel Rosland, Ida Blom and Karen Helle deserve special mention, as well as Iris Borowy for heading my final seminar. I am grateful to the organizers, opponents and commentators at the various workshops and conferences where I have presented parts of my research, especially Kathleen Vongsathorn and Monica Green. I am also grateful for the generous assistance offered by the staff at the University of Bergen Library, the Wellcome Library in London, the College of Physicians of Philadelphia’s Historical Medical Library, the State Archives in Bergen and at the League of Nations Archives in Geneva. 4 To my colleagues in Bergen, thank you for a good working environment. I would especially like to mention Gunnar Ellingsen, Runar Jordåen and Dunja Blazevic. I will always remember the lunches in Øysteinsgate 3 and Dokkeveien 2. Cecilie Boge, Svein Kåre Sture, Jan Oldervoll, Frode Ulvund, Arne Solli, Anne Mailin Selland, Sven-Erik Grieg-Smith, Hilde Grønvik, Bjørnar Mortensen Vik, Rune Hornnes, Per Kristian Sebak, Dag Hundstad, Eirik Hovden, Harald Stokkedal Bokn, Thomas Slettebø, Evind Urkedal York, Ingrid Birce Muftuoglu, Helen Leslie, Synnøve Lindtner, Pål Berg Svennungsen and Karine Aasgaard Jansen, thank you. Thanks also to the members of the editorial board of Historikeren. I am also grateful for the friends and colleagues I have made around the world, especially Lauren Cracknell, Bill MacLehose, Tom Quick, Adam Wilkinson, Åsa Jansson, Chris Millard, Anne Hardy, Sarah Chaney, John Mathew, Jordan Knapp, Lisa Tassone Knapp, Chantal Marazia, Fabio De Sio, Jenny Adlem and Tony Gould. Many thanks also to Alison, Francisco, Katrina, Paola, Isabel, Miguel and Anna- Karin who have made me feel welcome on my trips to Umeå. Thanks to my friends for patiently enduring my constant anecdotes from the history of leprosy and having to suffer my unfinished arguments on how the different elements were connected. Andreas, Henning, Jan, John, Kiel, Idunn, Marie, Eirik, and Ørjan – you have kept me sane. I am especially thankful to Andreas Berre for collaborating on a digital tool for mapping the circulation of knowledge.1 Although this sidetrack did not make the final cut, it helped me clarify my perspectives.Finally, I would like to thank my family, Dag and Eva for always being available to read my unfinished manuscripts, and Sara for being my sister and all that that entails. And, because in Guatemala the most important person is always left for the very end, I would like to thank Lorena for making a family with me. I love you. 1 Berre, Andreas. lepraMap; Prototyping a Tool for Modeling Historical Sources. MA-thesis. Molde University College. 2011. Online: http://brage.bibsys.no/hsm/retrieve/1318/master_berre.pdf. My comments on the collaboration is found in Berre 2011: Appendix 1. The source code for the project is available online: https://github.com/andreasBerre/lepraMap, and parts of the project was presented in the paper “Transdisciplinary history of medicine: A ‘Mode 2’-approach” at the conference “The Future of Medical History” arranged by the Wellcome Centre for the History of Medicine in London in July 2010. 5 Contents ACKNOWLEDGEMENTS .............................................................................3 CONTENTS ......................................................................................................5 1. INTRODUCTION ........................................................................................9 THREE DEBATES ...........................................................................................15 OUTLINE AND RESEARCH STRATEGY............................................................27 SOURCES: ‘BACKWARDS’ AND ‘SIDEWAYS’.................................................33 ‘THE LEPER’, TERMINOLOGY AND ETHICAL CONSIDERATIONS ....................38 LEPROSY TODAY...........................................................................................40 2. RECOGNIZING ‘THE LEPER’ ..............................................................45 BACKWARDS FROM THE CORPSE ..................................................................47 OF PATHOGENS AND EXPERTISE ...................................................................51 A NOSE FOR THE ULTIMATE PROOF...............................................................57 SHOWCASING THE LIVING BODY ..................................................................66 THE ELUSIVE TEST ........................................................................................70 DIAGNOSTIC PLURALISM AND LOCAL VARIATIONS ......................................74 CONCLUSION ................................................................................................81 3. TREATING LEPROSY: CARE OR CURE?..........................................85 THE TUBERCULIN TRIALS .............................................................................86 SPREADING THE RESULTS .............................................................................91 RUBBING LOTION ON THE SKIN .....................................................................96 SERUM FAILURE AND A NEW BENCHMARK.................................................101 LEPROLIN: TUBERCULIN FOR LEPROSY ......................................................105 NASTIN OVER THE COUNTER ......................................................................111 DID THE TREATMENTS WORK? ...................................................................118 6 THE BEST CASE SCENARIO.......................................................................... 125 REINVENTING CHAULMOOGRA .................................................................. 129 CONCLUSION .............................................................................................. 142 4. THE QUESTION OF PREVENTION................................................... 147 QUARANTINE: STOPPING LEPROSY AT THE BORDER .................................. 149 THE RISE OF SEGREGATION: TOWARDS BERLIN 1897................................ 158 PUSH, PULL, RESTRICT ................................................................................ 173 A MATTER FOR THE STATE ......................................................................... 183 BURNET’S COMPROMISE ............................................................................ 187 CONCLUSION .............................................................................................. 195 5. APPROPRIATING CONTAGION........................................................ 199 BEFORE LEAVING INDIA ............................................................................. 201 REPORTING HOME; FALLING FROM GRACE ................................................. 204 MEANWHILE, IN NORWAY.......................................................................... 212 CONTAGION AND THE LAW ........................................................................ 224 ENTER THE BACILLUS ................................................................................. 232 PROOF AND HUMAN EXPERIMENTS ............................................................ 245 REMATCH IN THE BRITISH EMPIRE............................................................. 247 CONCLUSION .............................................................................................. 256 6. CONNECTING THE WORLD OF LEPROSY.................................... 259 THE RISE OF INTERNATIONAL CONGRESSES